0:00

This is a 40 year old female presenting for a routine baseline screening

0:07

mammogram. We can see, first of all, in this case that the technique

0:14

image quality is not that great. On both of the MLO views, we

0:18

rarely see any pectoralis muscle here on the right hand side

0:23

and virtually none on the left hand side. This would not be great

0:27

and probably recommend some additional views just for technical

0:32

quality. In this case, the patient was not very tolerant of mammographic

0:38

positioning, and so this was the best that the technologist could do.

0:43

Looking sort of globally, we see some calcifications here in the right breast.

0:48

This grouping here, and this one here and this here.

0:52

On the left side, it looks normal. Pull down just the right hand side. On

0:58

the right as we get a closer look, we'll look at this group

1:01

of calcifications here. These have more stereotypical appearance of classic

1:05

fat necrosis. Right? They're rim oriented calcifications. I see the associated

1:12

circumscribed mass with it. And the right side, again, we see that small

1:19

rim calcified mass. This is classically benign, nothing we can do about

1:23

that. Further medial in the breast, in the CC view, we see this

1:29

grouping of amorphous calcifications in quite a large group.

1:35

Measuring, let's see what we got here, maybe about two and a half centimeters

1:38

or so. On the MLO view, we see the corresponding group of calcifications

1:44

here, putting this group of calcifications in the right breast at approximately

1:48

one o'clock posterior depth. And this is a screening exam, so she got

1:52

called back for further evaluation. But let's look at the tomosynthesis

1:57

images just for completeness. As we scroll through this area, we can see

2:01

these amorphous calcifications. And amorphous means that there's not a real

2:05

distinct shape or size that we can tell.

2:09

People describe it more classically as kind of grains of sand appearance

2:13

in the mammogram. And we sort of get that sense in both of

2:17

the views. You could argue for sure in this case that there are some

2:22

associated asymmetry with these calcifications, and I would agree with that

2:25

as well. So if we didn't see these

2:30

very well, you could potentially try to find them by ultrasound if you

2:33

wanted to. It's a little bit more challenging to do, but at least

2:38

in theory possible with the associated asymmetry. But this patient ended

2:41

up getting magnified mammographic views, our standard workup for calcifications.

2:48

And again, in the medial right breast, we see these amorphous calcifications

2:51

that are really difficult to see on this view. There's probably a little

2:54

bit of motion here as well, but not easy.

2:59

Similarly, on the ML view, we see those same calcifications here.

3:03

It's clouded a little bit by the heterogeneously dense

3:07

tissue, which is making it more difficult to see these calcifications. We

3:11

can partially see that rim calcified mass we described earlier.

3:14

Regardless, these amorphous calcifications are considered suspicious. They'd

3:18

be given a BI RADS 4B and recommended for biopsy. This patient subsequently

3:24

underwent image guidance, stereotactic biopsy, and this was biopsy proven

3:28

malignancy.